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June 27 - June 30, 2020
In a display of her extraordinary strength of personality, she renamed my brother “Mark,” and it stuck.
The Iraq they knew was lost, replaced by war and ruins. In my mind, this lost Iraq is a land of enchantment and despair. But its lessons endure. They may be unseen, but they are not forgotten, just as Mark is still Muaked—and
her foreign degree was all but meaningless in America.
There are lots of villains in this story. A disaster of this scale does not happen completely by accident. Many people stopped caring about Flint and Flint’s kids. Many people looked the other way. People in power made tragic and terrible choices—then collectively and ineptly tried to cover up their mistakes. While charges have been brought against some of the individuals who were culpable, the real villains are harder to see.
Because the real villains live underneath the behavior, and drive it. The real villains are the ongoing effects of racism, inequality, greed, anti-intellectualism, and even laissez-faire neoliberal capitalism.
Resilience isn’t something you are born with. It isn’t a trait that you have or don’t have. It’s learned.
Resilience is the key, the deciding factor between a child who overcomes adversity and thrives and a child who never makes it to a healthy adulthood.
Wearing the coat always made me feel better, stronger, protected—it was my armor.
As Frederick Douglass said, “It’s easier to build strong children than to repair broken men.”
There’s an expression I have always liked, a D. H. Lawrence distillation: The eyes don’t see what the mind doesn’t know.
Navy SEALs and other special ops medics train in Flint because the city is the country’s best analogue to a remote, war-torn corner of the world.
Physicians need to be trained to see symptoms of the larger structural problems that will bedevil a child’s health and well-being
Years ago we talked about these environmental factors as “social determinants of health.” Today we call them “adverse childhood experiences” (ACEs) or “toxic stresses.”
The other new concept is our realization that a child’s neuro-endocrine-genetic physiology can be altered. Prolonged, extreme, and repetitive stress or trauma—due to exposure to an ACE, including poverty, racism, violence—chronically activates stress hormones and reduces neural connections in the brain, just at the time in a child’s development when she should be growing new ones.
Maybe being the valedictorian came with unsustainably high expectations.
Time and love had brought out the best in my dad, buffering the trauma of his past. Resilience, I knew firsthand, could be learned.
Layers of accountability and responsibility had been stripped away.
Politics is about how we treat one another, how we sustain and share our common spaces and our environment. When people are excluded from politics, they have no say in the common space, no sharing of common resources. People may think of this as benign neglect, but it isn’t benign. It is malignant—and intentional.
That is precisely why public health surveillance programs are crucial. They regularly monitor population-wide trends that individual doctors can’t detect on their own—whether it is the flu, HIV, cancer, or blood-lead levels. This is what government public health people are charged to do. It is an invaluable way of discovering paradigms.
But even when lead exposure is demonstrated across a population, it is almost impossible to prove causation.
he opened my eyes to how wishful thinking can be used to obscure the facts, leaving out inconvenient truths and lessons.
“My interest is in the future, because I am going to spend the rest of my life there.”
This established a new precedent—later used by the asbestos and tobacco industries for decades—that forced public health advocates to prove harm before action could be taken. It goes against prudence and any sort of good judgment to allow dangerous practices to continue until enough evidence mounts to stop them—putting
“Safe until proven dangerous” became known as Kehoe’s Paradigm, or the Kehoe Rule. The approach was later taken by climate change deniers.
The public health approach, however, is far wiser than the Kehoe Rule. The Precautionary Principle holds that a product or chemical should be considered unsafe unless the manufacturer can prove otherwise.
His work added more lead to the environment and to children’s blood than any other application of the metal. It is one of the largest environmental crimes ever. Tell me again why we’re naming universities after him?
Experience had taught her that leaders can be evil and do evil—not just Iraqi leaders but people in power anywhere, anyone who sees people as disposable instruments in their own plans.
A sea of red tape lay between me and an official health advisory, which would hopefully free up resources and qualify the city for bottled water, filters, and other aid.
He fought for something bigger than a country or a religion, a tribe or an ethnic group. He fought for all people, for humanity, with a hope that there was another way to live.
Challenging injustice means standing up for the weak, the vulnerable, the abused, and the forgotten—be it in health, employment, education, or the environment. It means being vigilant on behalf of people who are treated as pariahs and scapegoats, populations that are dehumanized, displaced, and treated as disposable. It means fighting oppression at every opportunity—no matter the place or country.
thought I was just a doctor.
Finally, somebody was thinking about the science and methods instead of ridiculing me and calling me “unfortunate” and “hysterical.”
Finally the state had stopped fighting my research and conceded there was a problem, but it still seemed to be fighting the idea that it had anything to do with the creation or mitigation of the disaster.
Complete lack of aaccountability
Exchanges between state officials in 2015, released through FOIA, many of them Marc’s requests, show how they defended their flawed science. In shockingly flip and derisive language, they spent so much time creating extensive “talking points” to explain why they were right and everybody else was wrong. They made no attempts to get to the bottom of anything; their only goal was to recast and massage their lies.
were arranging for water coolers to be delivered to the Flint State Office Building so state employees wouldn’t have to drink from the tap.
We found out later that the city, controlled by the state, had deliberately manipulated the water samples from Flint homes so they wouldn’t have to notify the public about the presence of lead, per the federal rules.
When high-lead samples came back, they were thrown out,
I was in a room full of the people who had poisoned a city to save money. I was behind enemy lines.
I was a trophy—and captive.
If I had to locate an exact cause of the crisis, above all others, it would be the ideology of extreme austerity and “all government is bad government.” The state of Michigan didn’t need less government; it needed more and better government, responsible and effective government.
“This is a racial crime. If it were happening in another country, we’d call it an ethnic cleansing.”
Never had a government report explicitly stated the role of race in an environmental crisis.
Like lots of young people, I was drawn to advocacy, but the chance to really do something meaningful had come by accident.
Yes, people are still running to America, or at least trying to. It remains the epitome of prosperity for the entire world, the richest country that ever was. But there really are two Americas, aren’t there? The America I was lucky to grow up in, and the other America—the one I see in my clinic every day. In that other America, I have seen things I wish I’d never seen. The things you run from, not toward. Things that would never be part of any dream. And for too many people, this nightmare is taking place right outside their front door.
The most important medication that I can prescribe is hope.
